Telehealth Growing, But Needs A Boost

Telehealth holds promise and is advancing. Yet licensing reforms are needed nationally, as is greater clarity in Washington state on reimbursement rates. Photo: Army Medicine.

Over the next 10 to 15 years, Washington is expected to face a shortage of 3,000 to 4,000 doctors and 24,000 registered nurses. Already, patients are overusing emergency rooms to compensate for lack of access to primary care physicians. State lawmakers hope the expansion of telehealth will make care more affordable and accessible.

After a 2015 state law that expanded potential coverage, Washington lawmakers this year directed a stakeholder panel to begin developing recommendations on an important missing policy piece, reimbursement rates for telemedicine, a key component of telehealth.

At the same time, telehealth advocates are suggesting Congress make it easier for doctors to provide remote care across state lines through licensing reforms.

What Telemedicine Can Do

Through audio and video technologies like Skype and FaceTime, telemedicine can help deliver care for aging and underserved populations. It can reduce office wait times, and cut unnecessary emergency room and office visits for medical conditions that may not warrant in-person treatment.

For some, it provides a means of treatment in non-traditional settings such as homes, long-term care facilities, nursing homes, schools, or prisons.

A telemedicine service provided at Providence Health and Services eXpress in Washington allows doctors to treat patients outside of traditional office hours. Doctors are accessible from 8 a.m. to midnight, seven days a week.

Rural Communities Benefit

“In central and eastern Washington, especially in smaller communities where they’re miles away from the nearest clinic or nearest provider, we see telemedicine as…a great asset in taking care of these people and delivering health care,” said health care policy analyst Dr. Roger Stark, MD, with Washington Policy Center.

“It’s not intended for emergency services or a cure all for everything. It’s for the smaller things…more routine illnesses,” said Senator Jan Angel (R-26), a member of the Senate Health Care Committee.

“It’s a first, initial step,” said Sen. Angel. “Then I think it can lead to whether you should call your local doctor.”

“We are facing a huge provider shortage in this country especially now with the 20 million newly insured,” said Stark. Telehealth is “not going to change the number of providers,” he added. “It’s just going to make them more efficient.”

There are limitations. These include the range of conditions doctors can treat off-site, and the lack of hands-on treatment. A potential downside of telehealth is misdiagnosis.

Stark said that shouldn’t be seen as a deterrent.

“You can look at telemedicine as being sort of a first step,“ said Stark. He said if patients are being treated for the flu via telehealth and aren’t getting better, a physician would recommend they come into the office, rather than continue treatment virtually.

Stark added, “A lot of people go into the emergency room and they get a certain diagnosis and it may not be exactly correct and they come back a couple days later and get re-diagnosed…so it’s no different than that. There are limitations to it, there’s no question. You’re not going to have your knee replaced via Skype or have heart surgery via Skype,” Stark said.

More Work To Do For State Lawmakers

Washington state legislators have recognized the importance of telemedicine. They passed SB5175 in April of 2015 with bipartisan support, to expand coverage for telemedicine services paid by health plans. However, unlike for in-office visits, the bill doesn’t set a reimbursement rate for telemedicine treatment. The law takes effect January 1, 2017.

To address this shortcoming, legislators passed SB6519 in March of this year.

According to the Senate 2016 Interim Committee Work Plan, the bill creates a stakeholder body on telemedicine to “develop recommendations on improving reimbursement and access to services, identify…best practices, and make recommendations on whether to create a technical assistance center to support providers in implementing or expanding services…”

The advisory group includes legislators, academics, care providers, and insurers.

State Rep. Marcus Riccelli (D-3) is Vice-Chair of the House Healthcare Committee. He said he was “very pleased” legislators were able to take the next step earlier this year and that establishing reimbursement rates is key. “There have to be incentives for providers. Until there is certainly around the practice” of telemedicine, “it’s hard for them to engage.” He added, “We’re the technology state. We should be on the cutting edge.”

Licensing Reforms Eyed

Another key policy concern for telehealth advocates is that under the current system of state-by-state licensing, providers can only treat patients who reside in their state. That is a problem, says Kate Blackman, a policy specialist with the National Conference of State Legislatures. “If you’re a provider in Oregon and want to serve patients in Washington, you could also just get a license in Washington. But there are obviously different fee requirements.”

To apply for a physician’s license in Washington, a $491 fee is required and a biannual renewal runs $657. A renewal in California, on the other hand, comes to $820. To hold multiple licenses in different states would cost a physician thousands of dollars every two years.

To address that challenge and advance telemedicine, the Interstate Medical Licensure Compact is now enacted by 17 states. It allows providers in member states to serve patients from any other member state, including remotely.

Riccelli sponsored related bi-partisan legislation to put Washington in the multi-state compact. HB 2542, It cleared the Washington House in 2016 but stalled in the Senate. He said he expects to sponsor the bill in the House again in 2017. Especially where there is certainty on telemedicine reimbursement rates, a multi-state licensing compact can improve consumer choice and expand care options, Riccelli said.

“We have such a shortage of any health professionals, that anything we can do in this regard is a huge step forward,” said Sen. Angel.